Systemic steroids and autoimmune conditions pt 2 Flashcards
Symptoms of systemic lupus erythematosus
Fatigue, depression, anorexia, weight loss, muscle pain, malar rash (butterfly rash), arthritis symptoms, photosensitivity
What contributes to morbidity and mortality of SLE?
Renal, hematologic, and neurologic manifestations Lupus nephritis (kidney disease) develops in over 50% of patients with SLE
Chronic therapy options for SLE?
Limit steroids, may use NSAIDs at anti inflammatory doses
Use hydroxychloroquine, cyclophosphamide, azathioprine, mycophenolate, mofetil, and cyclosporine
(These drugs are discussed in other chapters, only hydroxychloroquine has an FDA indication for SLE)
Takes up to 6 months to see maximal benefit
Belimumab brand, dose, warnings
Benlysta
10 mg/kg every 2 weeks for 3 doses then every 4 weeks therafter; infuse over 1 hour
SC 200 mg SC weekly
Stable in NS only
Warnings: infection risk, dont give with other biologic DMARDs or other live vaccines
What is multiple sclerosis?
Chronic, progressive autoimmune disease where the patient’s immune system attacks the myelin sheath (the fatty substance that surrounds and insulates the nerve fibers of the brain and spinal cord axons)
What is the goal of treatment of MS?
Prevention of disease progression, what is lost in neuronal function cannot be regained
What drug classes are mainstay of treatment for patients with relapsing forms of MS?
Interferon beta formulations (Betaseron, Avonex, Rebif, Extavia, Plegridy) and glatiramer acetate (Copaxone, Glatopa) - parenteral drugs
Which interferon beta formulation has SC dosing every 14 days?
Plegridy
PEGylated interferon beta
Oral options for MS? (oral immune modulators)
Tecfidera (dimethyl fumarate)
Gilenya (fingolimod)
Aubagio (teriflunomide)
Glatiramer acetate brand, dose, dose form, side effects
Copaxone, Glatopa
Prefilled syringes
20 mg SC daily or 40 mg SC 3x weekly (at least 48 hours apart)
Side effects: injection site reactions, infection, pain, flushing, diaphoresis, dyspnea
Preferred in pregnancy!
2 dif doses - 20 mg daily or 40 mg MWF
Interferon beta-1a brand, dose forms, dose
Avonex, Avonex pen
Powder or pre-filled syringe/pen
30 mcg IM weekly OR 22 mcg or 44 mcg SC MWF
Interferon beta-1b brand, dose forms, dose
Betaseron, Extavia
Powder or auto-injector
0.25 mg every other day
Peginterferon beta-1a brand, dose forms, dose
Plegridy, Plegridy Starter Pack
Pre-filled syringe and pen
63 mcg on day 1, 94 mcg on day 15, 125 mcg every 14 days starting day 29
Warnings, side effects, notes for interferon beta products
Warnings: psychiatric disorders (depression, suicide)
injection site necrosis
increased LFTs
Thyroid dysfunction (hyper or hypo)
Side effects: flu-like symptoms
Notes: refrigerate all except Betaseron and Extavia (room temp)
If refrigerated, let stand at room temp prior to injection
Do not expel small air bubble in pre-filled syringes due to loss of dose
Oral immune modulators warnings, side effects, notes (just underlined stuff)
Teriflunomide
Fingolimod
Dimethyl fumarate
Teriflunomide (aubagio): contraindicated in pregnancy
Fingolimod (Gilenya): can cause bradycardia, monitor for at least 6 hours after 1st dose. ECG required at baseline, contraindicated in most patients w history of CV or stroke. Can cause macular edema, monitor with eye exams Monitor CBC (myelosuppression) and LFTs (hepatotoxicity)
Dimethyl fumarate (Teclidera) Do not crush, chew, or sprinkle capsule contents on food
Drugs for Raynaud’s phenomenon
This is where you have vasospasm in extremities, usually fingers and toes
Extremities turn white and then blue then painful swelling
Nifedipine used for prevention but other CCBs can be used
Also use vasodilating agents: iloprost, topical nitroglycerin, and the phosphodiesterase-5 inhibitors
Treatment of Celiacs disease
Avoid all gluten obviously but this includes medications
Package inserts contain info on excipient components, look for key word “starch” (corn, potato, tapioca, OR wheat)
If it lists starch alone, manufacturer must be consulted to find out if the starch is wheat
What is Sjrogen’s syndrome? Treatment options?
Autoimmune disease mostly characterized by severe dry eyes and dry mouth, but can be associated with other symtpoms like thyroiditis, Raynaud’s, neuropathy, and lymphadenopathy
Dry eyes try artificial tear drops, if not can use Restasis (cyclosporine emulsion eye drops) or lifitegrast (Xiidra)
Dry mouth use lozenges, or can use muscarinic agonists (pilocarpine)
What is psoriasis?
Autoimmune disease that appears on the skin
Most often appears as plaque psoriasis, which appears as raised, red patches covered with a silvery white buildup of dead skin cells on any part of the body
Drug treatment options of psoriasis
Topical treatments (steroids, coal tar products (messy))
Systemic: tablets (Otezla, or apremilast; Soriatane, or acitreten - use in severe cases only)
IL antagonists: monoclonal antibodies (Siliq, Tremfya, Stelara)
Notes, warnings for IL receptor antagonists
Subcutaneous injections
Can result in serious infections, so must screen for latent TB before starting and treat if positive and also avoid live vaccines
May cause diarrhea
